Registering allows us to provide you and your agency with greater personalization and security. It's a simple process and takes only a few minutes. From this page, you can begin the registration process for your agency (or MGA, etc.) and/or yourself.

There are supporting documents required to complete your registration. You'll receive a notification from us in 24-48 hours asking for these documents and for an electronic signature on the Broker Agreement. Please be sure you have these documents available for upload.

  • Your agency's insurance license(s)
  • E&O dec page or certificate
  • Current W9 - signed and dated within the last 6 months (download below)
  • ACH Agreement (download below)
  • Broker Agreement

Download and complete the following documents. They, along with all the documents found in the bullet list above, are required to complete your registration.

Broker
Your Agency
Have you ever had a license denied or revoked by any state (except for failure to pass the initial examination)?
Are you, as an agent, indebted to any insurance company, general agent, manager, or broker, or are any of the same claiming that you are indebted to them?
Have you filed for bankruptcy, court protection, or reorganization during the past five years, or is any bankruptcy proceeding filed by your still pending?
Have you ever been convicted of a felony or disciplined, fined, or censured by a state insurance department or any regulatory body or court?
Are you now the subject of any complaint, investigation, or proceeding that could result in a yes answer to any of the previous questions?
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